Cardiovascular Physiology in Exercise and Sport

By

Christopher Bell

This title is directed primarily towards health care professionals outside of the United States. Written by an eminent cardiovascular physiologist with a strong track record in dealing with issues related to exercise and environmental physiology, this text covers cardiovascular function from the exercise and human physiologist's viewpoint. It provides a solid foundation of knowledge of how the cardiovascular system responds and adapts to the challenges of exercise and environmental change, and analyses the practicalities of measuring cardiovascular parameters in normal human subjects.

Audience2nd and 3rd/final year undergraduate and postgraduate students in exercise physiology, human physiology and cardiac rehabilitation.

Contents

Chapter 1 - INTRODUCTION

After reading this Chapter, you should appreciate that absolute work capacity is ultimately limited by cardiovascular performance, understand the overall cardiovascular changes that occur during acute exercise and be ready to track the mechanisms that underlie these changes through the succeeding Chapters. * THE WHOLE-BODY RESPONSE TO EXERCISE

Chapter 2 - CARDIAC ACTIVATION

After reading this Chapter, you should understand the functional characteristics that allow the heart to operate efficiently at rest and during exercise, appreciate how the electrocardiogram can be used to obtain information on the normal heart and be able to recognise the main cardiac arrhythmias that are likely exclusion criteria for participation in exercise programmes. * REVISION OF REQUIREMENTS FOR AN EFFECTIVE HEART * DERIVATION OF ECG FROM THIS DESIGN * ARRHYTHMIAS IN THE NORMAL HEART * RECOGNITION OF ARRHYTHMIAS THAT MAY PRECLUDE * EXERCISE

Chapter 3 â CARDIAC OUTPUT

After reading this Chapter, you should understand the factors that determine cardiac output, know the mechanisms by which cardiac output is increased during exercise, know the importance of intraventricular turbulence and be able to assess which methods for non-invasive measurement of cardiac output are most appropriate for use at rest and during exercise. * FACTORS CONTRIBUTING TO CARDIAC OUTPUT DURING * EXERCISE * MAXIMUM CARDIAC OUTPUT DURING EXERCISE * IMPORTANCE OF CARDIAC TURBULENCE * PRACTICAL APPROACHES TO MEASUREMENT OF CARDIAC OUTPUT

Chapter 4 - BLOOD PRESSURE

After reading this Chapter, you should understand the factors that determine arterial blood pressure, be able to predict how systolic, diastolic and pulse pressures will be changed by altered cardiac performance and peripheral resistance, and be able to assess which methods for measurement of blood pressure are most appropriate for use during exercise. * DETERMINATION OF SYSTOLIC ARTERIAL PRESSURE * DETERMINATION OF DIASTOLIC ARTERIAL PRESSURE * SIGNIFICANCE OF MEAN vs PHASIC PRESSURE * DIFFERENCES BETWEEN CENTRAL & PERIPHERAL PULSE PRESSURE * PRACTICAL APPROACHES TO MEASUREMENT OF BLOOD PRESSURE

Chapter 5 - VASOMOTOR REGULATION IN EXERCISE

After reading this Chapter, you should understand the basic patterns of brain control over sympathetic cardiovascular pathways, be able to predict how cerebral arousal and exercise affect blood pressure and regional blood flows and appreciate the different effects of dynamic and resistive exercise on these parameters. * LOW PRESSURE AND HIGH PRESSURE BAROREFLEXES * ANTICIPATION OF EXERCISE * EFFECT OF EXERCISE ON BLOOD PRESSURE * EFFECTS OF EXERCISE ON DISTRIBUTION OF CARDIAC OUTPUT * DYNAMIC vs. RESISTIVE EXERCISE

Chapter 6 â THE VASCULAR SYSTEM

After reading this Chapter, you should understand the factors that determine peripheral vascular resistance, appreciate the differences between flow in rigid and distensible vessels, know the effects of Laplaceâs law on the circulation and be able to describe the ways in which structural specialization of vessels can be important in optimizing the thermoregulatory role of the circulation. * DETERMINATION OF FLOW BY PRESSURE AND RESISTANCE * FACTORS AFFECTING RESISTANCE * DERIVATION OF POISEUILLEâS EQUATION * ELASTIC PROPERTIES OF BLOOD VESSELS * CRITICAL CLOSING PRESSURE * COUNTER-CURRENT HEAT EXCHANGE * ARTERIOVENOUS SHUNTING AND HEAT EXCHANGE

Chapter 7 â LOCAL REGULATION OF PERIPHERAL VASCULAR FUNCTION

After reading this Chapter, you should be able to identify the main local factors that regulate microcirculatory vascular resistance and describe the roles of these factors in determining regional blood flows at rest and during exercise. * REACTIVE AND FUNCTIONAL HYPERAEMIAS * VASOMOTION * AUTOREGULATION * EFEFCTS OF LOCAL TEMPERATURE * COMPETITION IN FUNCTIONAL HYPERAEMIC RESPONSES * LOCAL REGULATION OF VASCULAR FUNCTION IN DIABETES

Chapter 8 - MEASURING PERIPHERAL VASCULAR FUNCTION

After reading this Chapter, you should know the techniques available for measurement of blood flow to skin and muscle during exercise, understand how the pulse wave can be used to assess peripheral resistance and arterial compliance and be able to choose the most appropriate technique for monitoring plasma loss via sweat production. * PRACTICAL ASSESSMENT OF SKIN BLOOD FLOW * PRACTICAL ASSESSMENT OF MUSCLE BLOOD FLOW * ESTIMATION OF PERIPHERAL RESISTANCE * ESTIMATION OF ARTERIAL COMPLIANCE * TECHNIQUES FOR QUANTIFYING PLASMA LOSS VIA SWEATING

Chapter 9 - PULMONARY VASCULAR FUNCTION

After reading this Chapter, you should understand the advantages and disadvantages of the low perfusion pressure gradient through the pulmonary circulation, know the mechanisms by which ventilation and perfusion are matched during exercise, and appreciate the effects of some common congenital cardiac defects on the efficiency of pulmonary perfusion during exercise. * PRACTICAL CONSEQUENCES OF LOW PULMONARY PRESSURE * FUNCTIONAL CONSEQUENCES OF LOW PULMONARY PRESSURE * REGIONAL MATCHING OF VENTILATION AND PERFUSION * PRENATAL PULMONARY VASCULAR FUNCTION * IMPLICATIONS FOR EXERCISE OF COMMON CONGENITAL CARDIAC DEFECTS

Chapter 10 â CIRCULATORY LIMITS TO EXERCISE

After reading this Chapter, you should appreciate that exercise performance is normally limited by cardiovascular factors, know how to optimize exercise capacity by limiting fluid depletion, understand the impact of body size, gender and age on exercise performance and recognize the particular limitations to exercise imposed by some common clinical conditions. * LIMITS TO MUSCLE PERFUSION * FLUID MAINTENANCE STRATEGIES * EFFECTS OF DIFFERENT AMBIENT CONDITIONS * LIMITS OF SIZE, GENDER AND AGE * DIFFERENCES IN LIMITATION OF AQUATIC vs TERRESTIAL EXERCISE * EXERCISE IN PREGNANCY * EXERCISE IN SPECIFIC PATIENT GROUPS

Chapter 11 â ADVERSE CIRCULATORY EFFECTS OF EXERCISE

After reading this Chapter, you should appreciate the different ways in which fainting (syncope) may be produced during exercise, understand the potentially adverse effects of exercise on body temperature and body fluid content and composition, know the principles of how to deal with these problems and be able to identify some specific situations in which exercise may be life-threatening. * SYNCOPE * EFFECTS OF HEAT STRESS * SUSCEPTIBILITY OF CHILDREN AND ELDERLY * STRATEGIES FOR RESCUE AND RECOOLING * HAEMATOLOGICAL CHANGES * RENAL CHANGES * RHABDOMYOLYSIS AND GENETIC PREDISPOSITION * IMPLICATIONS OF DRUG INTOXICATION * SUDDEN CARDIAC DEATH IN YOUNG ATHLETES

Chapter 12 â CARDIOVASCULAR ADAPTATIONS TO TRAINING

After reading this Chapter, you should appreciate the changes in blood volume and cardiovascular structure and function that follow physical training, know the approximate extent to which these changes alter capacity for aerobic work and understand the roles for chronic exercise in treatment of common cardiovascular disease states. * ADAPTATIONS OF BLOOD VOLUME REGULATION * ADAPTATIONS OF VASCULAR FUNCTION * ADAPTATIONS OF CARDIAC FUNCTION * ROLE OF CHRONIC EXERCISE IN TREATING HYPERTENSION * ROLE OF CHRONIC EXERCISE IN TREATING DIABETES * ROLE OF CHRONIC EXERCISE IN CARDIAC REHABILITATION

Chapter 13 â EFFECTS OF HIGH ALTITUDE

After reading this Chapter, you should understand the acute and chronic effects of high altitude on exercise capacity, appreciate the rationale for training at altitude and comprehend the limitations of this as a practical approach to optimizing exercise performance. * EFFECTS OF ALTITUDE ON THE CIRCULATION *ADAPTATIONS TO ALTITUDE * DIFFICULTIES WITH PROLONGED EXPOSURE * IMPLICATIONS OF ALTITUDE FOR EXERCISE CAPACITY * IMPLICATIONS OF ALTITUDE FOR TRAINING * MIMICKING THE EFFECTS OF ALTITUDE IN TRAINING